Pelvic and Aortic Lymphadenectomy in Endometrial Cancer

Pelvic and aortic lymphadenectomy have been incorporated into the FIGO staging for endometrial carcinoma although the indications for lymphadenectomy were undefined. When lymphadenectomy is carried out, however, both the pelvic and para-aortic lymph nodes are usually removed. This policy has limited the ability to manage patients with endometrial carcinoma laparoscopically because many women who have endometrial cancer are obese, and aortic lymphadenectomy is frequently difficult to carry out in patients weighing 180 pounds or more. Data are presented to show that the presence of pelvic lymph node metastases provide a better criterion for aortic lymphadenectomy than deep myometrial invasion. If positive pelvic nodes rather than deep myometrial invasion were used as the criterion for aortic lymphadenectomy, 23% more women with aortic lymph node metastases would be identified, and 35% fewer aortic lymphadenectomies would need to be carried out, although these would need to be performed as a second operation. Data are also presented to show that pelvic lymphadenectomy can be carried out laparoscopically in women weighing 180 pounds or more. Our heaviest patient weighed 300 lbs. Because obese women tend to have more favorable lesions, few will be found to have pelvic lymph node metastases, and therefore few will require aortic lymphadenectomy. I conclude, therefore, that most women with endometrial carcinoma can be successfully managed laparoscopically if they are treated by laparoscopic hysterectomy and pelvic lymphadenectomy, and aortic lymphadenectomy is reserved for those who have positive pelvic nodes.